RESUMEN
Appropriate positive end-expiratory pressure(PEEP)level is an important component of protective lung ventilation strategy.PEEP can maintain the openness of alveoli and reduce lung collapse in-jury.Although individualized PEEP application has been increasingly recognized by clinical physicians,the optimal PEEP titration method is still controversial.Electrical impedance tomography(EIT)is a non-inva-sive and radiation-free imaging technique that can be used to dynamically assess lung function at the bedside.EIT presents changes in impedance during ventilation as dynamic images,which can reflect altera-tions in ventilation and gas distribution before and after PEEP adjustments.Therefore,EIT can be utilized to tailor individualized PEEP.This article provides a brief overview of the basic principles and monitoring pa-rameters of EIT.It elucidates the PEEP titration method under the guidance of EIT in clinical applications(PEEPEIT),aiming at enhancing the understanding of the advantages and limitations of EIT and providing reference for the setting of individualized PEEP.
RESUMEN
Objective To study the feasibility of using heat and moisture exchangers (HME)as an alternative to heated humidifiers (HH) in patients undergoing mechanical ventilation. Methods 266 pa-tients with mechanical ventilation admitted to our ICU over the recent 3 years were allocated to the experi-mental group (humidification with a heat and moisture exchanger) and the control group (with heated hu-midifier), and the effect of humidification, the reserved time of artificial airway, the time on mechanical yen-tilation, the time of stay in ICU, the ineidenee of ventilator-associated pneumonia (VAP) and the mor-tality rate were comparatively studied and analyzed. Results Significant differences were found between the experimental and the control group in effect of humidification, insufficiency of humidification or excessive hu-midification, airway spasm and time on mechanical ventilation and time of stay in ICU. The incidence of VAP in the control group was significantly higher than that in the experimental group. There were no significant dif-ference between the two groups in the reserved time of artificial airway and the mortality rate. There were no accident of humidification occurred in the experimental group while there were one case complicated with air-way burn and 11 eases complicated with choking with water in the control group. Conclusions We conclude that HH can be replaced by HME on mechanical ventilation while disease evolution and effect of humidification should be monitored closely and keep HME unobstructed.
RESUMEN
The recent development of laparoscopic cholecysteetomy has introduced the technique of laparoscopy to the general surgical operation. During this procedure, the deliberate pneumoperitoneum with carbon dioxide(CO2) insufflation in order to visualize better the abdominal viscera may causes some problems-hypercarbia, hypertension, pneumomediastinum, subcutaneous emphysema and cardiovascular impairment, We studied the changes of cardiovascular system and pulmonary gas exchanges clinically during general anesthesia for laparoscopic eholecystectomy in the 16 patients of Seoul National University Hospital. After induction of anesthsia, ventilation was controlled with tidal volume 10 ml/kg and respiration rate 10-15/min to maintain PaCO2 35 mmHg before insufflation of carbon dioxide. After measuring of control value of mean arterial pressure(MAP), heart rate(HR) and arterial blood gas analysis before insufflation of CO2, ventilation setting was not changed throughout the operation. MAP, HR, arterial blood gas analysis were measured at 30 min interval until the end of operation. The changes of MAP, HR and PaO2, throughout the operation are not statistically significant in comparison to control(preinsufflation) values. The PaCO2 was increased significantly by 8-10 mmHg in comparison to control values(p-value<0.01). In conclusion, minute ventilation should be corrected during general anesthesia for laparoscapic cholecysteetomy with CO2 insufflation according to continuous monitoring of end tidal CO2 and arterial carbon dioxide tension.